SUBSTANCE MISUSE - A PRIMARY RISK AND A MAJOR PROBLEM OF COMORBIDITY

The misuse of drugs or alcohol has long been regarded as a major risk factor for violence. This is confirmed by findings fi om the Epidemiol ogical Catchment Area (EGA) surveys which also show that comorbidity f or substance misuse and mental illness further increases the risk. In preliminary findings from the MacArthur Violence Risk Assessment study , it was found that over 40% of patients with a major mental disorder were comorbid for a substance misuse disorder and these individuals we re three to four times more at risk of showing violent behaviour. Revi ewing the ways in which taking drugs or alcohol may be associated with violence shows that pharmacological, psychological and sociological f actors may modify the expression of intoxicated or aggressive behaviou r. It is suggested that these findings should lead to a greater awaren ess of substance misuse issues in risk assessment and management. The implications of this for the delivery of psychiatric care and the orga nization of services are discussed.